Monday, October 1

Open Doctor Notes = empowered patients

Today the OpenNotes project published their final results  in the journal Annals of Internal Medicine and recommends giving patients access to the clinical portion of your medical record.. Many of us have been advocating for this for years and this is a game changer..

The study included over 100 doctors and over 13,000 patients at 3 facilities - Harborview Medical Center a level 1 Trauma center that also provides primary care to low income residents in Seattle as well as Beth Israel Deaconess Medical Center in Massachusetts, Geisinger Health System in Pennsylvania.

The results were pretty impressive. Over 87% of all patients open up at least one note.  99% of patients eligible to view notes said they wanted the program of "open notes" to continue, and no doctor said he or she was ceasing this practice.

Results: 11 797 of 13 564 patients with visit notes available opened at least 1 note (84% at BIDMC, 92% at GHS, and 47% at HMC). Of 5391 patients who opened at least 1 note and completed a postintervention survey, 77% to 87% across the 3 sites reported that open notes helped them feel more in control of their care; 60% to 78% of those taking medications reported increased medication adherence; 26% to 36% had privacy concerns; 1% to 8% reported that the notes caused confusion, worry, or offense; and 20% to 42% reported sharing notes with others. 

The volume of electronic messages from patients did not change. After the intervention, few doctors reported longer visits (0% to 5%) or more time addressing patients' questions outside of visits (0% to 8%), with practice size having little effect; 3% to 36% of doctors reported changing documentation content; and 0% to 21% reported taking more time writing notes. Looking ahead, 59% to 62% of patients believed that they should be able to add comments to a doctor's note. One out of 3 patients believed that they should be able to approve the notes' contents, but 85% to 96% of doctors did not agree. At the end of the experimental period, 99% of patients wanted open notes to continue and no doctor elected to stop.

Conclusion: Patients accessed visit notes frequently, a large majority reported clinically relevant benefits and minimal concerns, and virtually all patients wanted the practice to continue. With doctors experiencing no more than a modest effect on their work lives, open notes seem worthy of widespread adoption.

Here are some links

The research just published Inviting Patients to Read Their Doctors' Notes: A Quasi-experimental Study and a Look Ahead

An editorial Pushing the Envelope of Electronic Patient Portals to Engage Patients in Their Care

CNN coverage - Study: Doctors should share notes with you

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